Joint Glenohumeral

The shoulder complex consists of four distinct articulations the glenohumeral joint, the acromioclavicular joint, the sternoclavicular joint, and the scapulothoracic articulation. The wide range of motion of the shoulder (exceeding a hemisphere) is the result of synchronous, simultaneous contributions from each joint The most important function of the shoulder is arm elevation. Several investigators have attempted to relate glenohumeral and scapulothoracic motion during arm elevation in various planes... 

Table 49.13). About two-thirds of the motion takes place in the glenohumeral joint and about one-third in the scapulothoracic articulation, resulting in a 2 1 ratio. 

Karduna A.R., Williams G.R., Williams J.I. et al. 1996. Kinematics of the glenohumeral joint influences of muscle forces, ligamentous constraints, and articular geometry. /. Orthop. Res. 14 986. 

SahaA.K. 1971. Dynamic stability of the glenohumeral joint Acta Orthop. Scand. 42 491. 

Normal anatomy of the glenohumeral joint showing the bones, muscles, tendons, ligaments, and capsuie at the shouider in frontal section (A) and glenoid face (B) views. The superior (S), inferior (I), medial (M), lateral (L), anterior (A), and posterior (P) directions are also denoted on each view (images used with permission of Primal Pictures, Ltd., London). 

Poppen N.K., and P.S. Walker. 1978. Forces at the glenohumeral joint in abduction. Clin Orthop 135 165-170. 

Warner J.J., M.K. Bowen, X. Deng, et al. 1999. Effect of joint compression on inferior stability of the glenohumeral joint. / Shoulder Elbow Surg 8 31-36. 

Dislocation of the glenohumeral joint is uncommon under the age of 10, while approximately 20% of all traumatic dislocations occur between the ages of 10 and 20 (Rowe 1956). The presence of the humeral physis appears to be protective. Displacement is typically anteriorly with only 2%-4% of dislocations being posterior. 

Anderson SL, Buchko JZ, Taillon MR, Ernst MA. Chondrolysis of the glenohumeral joint after infusion of bupivacaine through an intra-articular pain pump catheter a report of 18 cases. Arthroscopy 2010 26 451-61. 

Musculoskeletal In two patients, injection of a low concentration of gentian violet into the glenohumeral joint, in order to visualize a rotator cuff tear during surgery, resulted in chondrolysis [55 ]. 

Shibata Y, Midorikawa K, Koga T, Honjo N, Naito M. Chondrolysis of the glenohumeral joint following a color test using gentian violet. Int Orthop 2001 25 (6) 401-3. 

The glenohumeral joint allows greater freedom of motion than any other joint in the body. The humeral head is convex and has a larger surface area than the concave glenoid fossa on which it moves. The humeral head slides along the surface of the fossa and rolls in various angular motions. 

The capsule of the glenohumeral joint is loose and pleated. The ligaments, which are merely thickenings in the capsule, provide little support. The major support of the humerus into the fossa is provided by the rotator cuff muscles, which hold the head into the fossa. These muscles include the supraspinatus, infraspinatus, teres minor, and subscapularis. Abduction-adduction and axial and horizontal rotations are coupled in that angular motions are accompanied by translatory slides. The caudal slide of the humeral head with abduction confers increased freedom of motion on the supraspinatus tendon beneath the coracoacromial ligament. 

The glenohumeral joint has three degrees of cardinal motion flexion and extension, abduction and adduction, and internal and external rotation. 

The suprahumeral joint acts in concert with the glenohumeral joint as the humeral head... 

The glenohumeral joint can be evaluated during us range of motion testing. Somatic dysfunction is diagnosed if there is no pathology of the joint Arthritis, tendonitis, or other pathology may be treated with appropriate osteopathic manipulation, but most responsive will be true somatic dysfunctions. 

FIG. 88-10 HVLA thrusting technique for glenohumeral joint somatic dysfunction. 

The physician exerts a rapid downward and slightly lateral force through the patient s glenohumeral joint (Fig. 88-10). 

Any joint in the upper extremity may dislocate if sufficient force is applied to it. The glenohumeral joint is especially prone to dislocating, usually in an anterior direction. A prominent end of the clavicle and loss of roundness of the shoulder may indicate a dislocation. Frequently there is an associated tear of the capsule. With any joint dislocation, radiographic imaging should be obtained to rule out an associated fracture. 

Any type of arthritis may involve any of the shoulder girdle joints. The sternoclavicular joint is most commonly affected. Osteoarthritis of the glenohumeral joint is less common than in some of the other upper extremity joints. 

---